Wiki CPT 99140

[fergerson_6@yahoo.com]

I am an anesthesia biller and the only way we had been able to get insurance companies to pay for CPT 99140 was add the 59 modifier. Our system has recently updated its clearinghouse and CPT code 99140 is now causing the claims to reject. So, we tried removing the 59 modifier but the claims are still rejecting stating that the parent code for AMA add on CPT/HCPCS code is not specifically identified in the CPT manual, confirm that an appropriate parent code has been coded. What could this rejection reason be referring to?

 

[CBLENNIE]

Well, this is an add-on code to the actual anesthesia code in the range of 00100-01999, are you billing 99140 on the same claim as you are billing the actual anesthesia code 00100-01999? I work for an insurance company, and we see claims with the 99140 billed on a separate claim than the actual anesthesia code, so this does happen in the real world.

If your claims have the anesthesia code on them in addition to the 99140 add-on code, it sounds like you need to contact the clearinghouse to see what this rejection is being caused by and what the solution to the rejection is. It could be as simple as they updated their system, and a mistake was made in the programming logic that is causing the rejection in error.

We're all human and as most of us here in the forums are well versed in programming updates that create unintended errors.

 

[LisaAlonso23]

59 is not meant to be appended to 99140, as 99140 is an anesthesia add-on code that indicates an emergent case in which the patient's life or limb is in danger. It is not a procedure and may not be billed alone. 99140 is only billed to commercial insurance for patients younger than one year and 70+ years of age. It is not billed to government insurance (ie, Medicaid, Medicare, managed Medicaid, Medicare Advantage Plans). I hope this helps.

 

[fergerson_6@yahoo.com]

59 is not meant to be appended to 99140, as 99140 is an anesthesia add-on code that indicates an emergent case in which the patient's life or limb is in danger. It is not a procedure and may not be billed alone. 99140 is only billed to commercial insurance for patients younger than one year and 70+ years of age. It is not billed to government insurance (ie, Medicaid, Medicare, managed Medicaid, Medicare Advantage Plans). I hope this helps.

Thank you for this explanation, I was under the understanding that you would bill 99100 when the patient is younger than 1 year and older than 70......but that also applies to when your billing 99140?

 

[fergerson_6@yahoo.com]

Well, this is an add-on code to the actual anesthesia code in the range of 00100-01999, are you billing 99140 on the same claim as you are billing the actual anesthesia code 00100-01999? I work for an insurance company, and we see claims with the 99140 billed on a separate claim than the actual anesthesia code, so this does happen in the real world.

If your claims have the anesthesia code on them in addition to the 99140 add-on code, it sounds like you need to contact the clearinghouse to see what this rejection is being caused by and what the solution to the rejection is. It could be as simple as they updated their system, and a mistake was made in the programming logic that is causing the rejection in error.

We're all human and as most of us here in the forums are well versed in programming updates that create unintended errors.

When our facility bills the 99140 code it is always billed with a actual anesthesia code. Do you know what they would be referring to when they say an appropriate parent code?

 

[CBLENNIE]

The anesthesia code from the 00100-01999 range is the parent code so it sounds like something is not quite right with your vendor. I would recommend you contact them to see if they made any changes or updates that may've caused you to start receiving rejections for 99140.

 

[LisaAlonso23]

Thank you for this explanation, I was under the understanding that you would bill 99100 when the patient is younger than 1 year and older than 70......but that also applies to when your billing 99140?

You're correct. 99100 is only billed for patients under 1 & over 70. However, which insurance we bill 99100 and/or 99100 to are the same. I edited my reply above. They are only billed to commercial insurance and not government insurance (ie, Medicaid, Medicare, managed Medicaid, Medicare Advantage Plans).